Ontario’s Health Insurance Plan (OHIP) covers the cost of most doctor, medical, ambulance services and emergency treatments as long as they are provided in Ontario.
When you travel to another province within Canada, OHIP covers the costs of emergency treatment at Ontario’s rates with Ontario’s limitations. This means if you were involved in accident outside Ontario, you could face an OHIP coverage shortfall and be forced to pay the difference.
In addition, emergency treatments provided by Chiropractors, Optometrists, Podiatrists and Osteopaths, as well as some medical services delivered in Quebec have reduced or limited coverage. Check the Health Insurance Act and its related regulations for complete OHIP eligibility and coverage restrictions.
What happens when you travel outside of Canada?
Will OHIP pay the same medical expenses that are covered in Ontario? The answer is NO.
OHIP provides very limited funding for a limited range of medical services when you travel outside of Canada. Only emergency health services are covered. To qualify as an emergency, the treatment must be medically necessary and must be performed at a licensed hospital or licensed health facility. The treatment must be rendered in relation to an illness, disease, condition or injury that is acute and unexpected and arose outside of Canada and requires immediate treatment.
What is not covered by OHIP?
If the treatment is not medically necessary or is rendered at a facility that is not licensed, there is no OHIP coverage. If the illness, disease condition or injury arose inside Canada, or the treatment is not generally accepted in Ontario, there is no coverage. Ambulance services or transportation costs are not covered.
It may be covered, but how much will OHIP pay?
OHIP will not pay more than the service would have cost in Ontario. For Physicians, OHIP will pay what was billed or the cost of the same physician service in Ontario, whichever is less. For health facility services, OHIP will pay $50.00 Canadian per day, except for dialysis patients who will receive $210 for each treatment. For most inpatient services, OHIP will pay $200 per day. For inpatient services rendered in an operating room, coronary care unit, intensive care unit, neonatal or pediatric special care unit, OHIP will pay up to $400 per day. The per day limits apply to hospital services including accommodations, meals, prescription drugs, surgically implanted devices and nursing services. OHIP does not pay for ambulance or transportation costs, out-of-hospital food or accommodations and non-prescription drugs.
Why Travel Insurance makes sense
Without travel insurance, a broken arm, or even something as basic as the flu, could lead to substantial medical bills costing thousands of dollars. Travel insurance can protect you in the case of medical emergencies, theft, lost baggage and last-minute plan changes. It is important that you read the exclusions and limitations so there are no surprises if you need to file a claim.
If you are planning a trip outside of Ontario, talk to us about travel insurance.
We’ll help you have a worry-free holiday.